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Running Head: COMMUNICATION ACCOMMODATION THEORY 1
Communication Accommodation Theory and its Application to Health Communication
Laura C. Bonfiglio
Radford University
COMMUNICATION ACCOMMODATION THEORY
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History of Communication Accommodation Theory
According to Gallois, Ogay and Giles, not only do theories “aim to capture the
complexity of life in formalized conceptions” but they also “have their own lives” (2005, p. 121).
The life of communication accommodation theory (CAT) can be traced back to the development
of speech accommodation theory (SAT) devised in the early 1970s by social psychologist
Howard Giles (Gallois et al., 2005). SAT sought to explain the effects linguistics had on
interactions between individuals (Gallois et al., 2005). Its creation can also be attributed to
social psychologists’ Taylor and Bourhis, whom along with Giles were unsatisfied with the
assertion that individuals change their linguistic styles in different scenarios. This assertion did
not settle well with these researchers, as it lacked explanation and support (Giles & Ogay, 2007).
Giles explained the motivating factor that drove his research on sociolinguistic behaviors when
he said his motivation “evolved in response to observing behaviors in my own and others’
speech styles, together with the consequent effects of these changes” (Giles, 2008, p. 121).
Specifically, he wanted to pinpoint what motivated individuals to make changes in their speech
styles, such as accent or bilingual shifts, when communicating with others (Giles & Ogay, 2007).
To address these concerns, Giles developed SAT, a socio-psychological model that
proposed “speakers use linguistic strategies to gain approval or to show distinctiveness in their
interaction with others” (Gudykunst, Lee, Nishida, & Ogawa, 2005, p. 14). It is with this claim
that the dominant accommodation strategies of convergence and divergence, prevalent in CAT
today, developed. Discussed later in further detail, convergence and divergence were the
original accommodation tactics recognized by the theory (Gudykunst et al., 2005). According to
Giles et al. (1987), in its early form, convergence was an act to achieve closeness in an
interaction through linguistic tactics such alterations in one’s “speech rate, pauses, pronunciation,
COMMUNICATION ACCOMMODATION THEORY
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and vocabulary” (as cited in Nussbaum, Pitts, Huber, Krieger, & Ohs, 2005, p. 290).
Conversely, strategies of divergence could deploy these same tactics, but they were used to
establish distance (Nussbaum et al., 2005). As these concepts were explored throughout the
1970s, Street and Giles finally proposed them in the early 1980s within the context of SAT
(Gallois et al., 2005). Shortly thereafter, Thakerar and colleagues advanced the original claims
to expand beyond an individuals desire to achieve intimacy or establish distance (Gallois et al.,
2005).
Thakerar and colleagues acknowledged that these accommodation strategies also served a
cognitive purpose extending beyond a speaker’s own intention. This extension brought attention
to the receiver in an interaction, specifically in regard to the speaker’s interpretation of the
receiver’s needs and comprehension (Gallois et al., 2005). Accordingly, during an interaction, a
speaker may converge their speech styles to meet the interpreted requirements of the listener.
For example, if communicators speak different languages, one, or both, interactant may alter
his/her speech style by slowing their speech to allow their partner time to interpret the message
(Gallois et al., 2005). Thakerar and his colleagues achieved this extension for convergence but
not for divergence (Gallois et al., 2005).
Shortly thereafter, Giles and Street considered divergence from a broader scope as well
(Gallois et al., 2005). Added to the theory was the claim that divergence can not only be used to
establish differences, but like Thakerar proposed for convergence, can also be used to achieve
comprehension (Gallois et al., 2005). For example, if a foreign language speaking individual
wants their communicative partner to understand they need more time to interpret their
messages, he/she may diverge by emphasizing their accent and language differences.
As researchers developed the theory and altered its propositions, the scope of SAT
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continued to expand. Not only were strategies of convergence and divergence used during an
interaction, but researchers also added the notion that communicators may shift back and forth
between the two in any given interaction (Davis, Spencer, & Ferguson, 2011). Coinciding with
interactants’ ability to shift accommodation strategies is the notion that communicators
“continuously re-evaluate their decisions” to do so (Davis et al., 2011, p. 1049).
Arguably the most significant development to the theory came with its name change to
CAT, when the communicative behaviors studied expanded beyond speech styles and
encompassed the entire communication process, including nonverbals (Gallois et al., 2005).
According to Gasiorek and Giles (2012), “the theory proposes that individuals make adjustments
to their communicative behavior as a function of their assessment of their conversational
partners’ communicative characteristics, as well as their desire to establish and maintain a
positive personal and social identity” (p. 310). As the theory’s application expanded, strategies
such as interpretability, discourse management, interpersonal control and emotional expression
strategies (Park & Watson, 2007; Murray-Johnson & McGrew, 2004) were integrated as
“attuning strategies” that are often used when one wishes to accommodate (Gallois, et al., 2005,
p. 134; Jones, Woodhouse, & Rowe, 2007).
According to Jones et al. (2007), interpretability strategies can be defined as tactics used
by an individual to either make their communication more understandable to their partner or not.
Discourse management is a strategy that may be utilized by interactants to manage the
conversation and needs of their communicative partner (Lee & Giles, 2008). Interpersonal
control strategies take into account “role relations” and may be utilized by communicators to
“direct and control an interaction” (Park & Watson, 2007, p. 8; Murray-Johnson & McGrew,
2004). Finally, emotional expression strategies are tactics that may be used during an interaction
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to attend or not attend to the relational needs of one’s communicative other (Park & Watson,
2007; Jones et al., 2007).
With the expansion of behaviors that can be analyzed according to CAT, the theory has
been applied to a variety of disciplines and contexts. Although most commonly studied and
applied within intercultural studies (Gallois et al., 2005), the theory has been applied to a wide
range of phenomena (Giles & Ogay, 2007). Areas of application include inter- and intra-
generational encounters (Lin & Zhang, 2008), police-civilian encounters (Giles et al., 2005),
health provider-patient/client encounters (D’Agostino, & Bylund, 2010), supervisor-subordinate
encounters (McCroskey & Richmond, 2000), and more. As CAT is wide in scope, this review
seeks to explain its key components, major developments and criticisms. Finally, this review
will conclude with CAT’s application to health communication (particularly regarding
interactions between health professionals and patients/clients), and it will end with suggestions
for future research of CAT’s applicability to the health communication context.
Components of Communication Accommodation Theory
According to Giles and Ogay, communication accommodation theory (CAT) “explores
the different ways in which we accommodate our communication, our motivations for doing so,
and the consequences” (2007, p. 16). The first component to the theory is the socio-historical
context of an interaction (Gallois et al., 2005). Before an interaction occurs between two parties,
there are pre-established relations between the individuals and the groups to which they belong
(Gudykunst et al., 2005). Specifically, communicators’ social belonging is made up of societal
and cultural norms and values (Gallois et al., 2005). The socio-historical context influences
communicators’ orientation to the upcoming interaction, as the larger social groups to which they
are members influence how they will approach the interaction (Gallois et al., 2005).
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The second component of CAT involves the stance each communicator assumes
regarding whether or not they are likely to perceive the encounter as inter-personal or inter-group
(Gudykunst et al., 2005). One may approach the interaction as inter-personal (based on one’s
uniqueness as an individual), or one may approach the interaction as inter-group (based on one’s
membership in a social group) (Gudykunst et al, 2005). According to Gudykunst et al., there are
three factors that influence an individual’s decision to approach the interaction as inter-personal
or inter-group. The decision is dependent on intrapersonal factors, intergroup factors or a
combination of the two (2005).
Intrapersonal factors involve one’s own social and personal identity (Gudykunst et al.,
2005). Intergroup factors involve one’s own tendency to view encounters in intergroup terms
(Watson & Gallois, 1998). Intergroup considerations also involve one’s perception of conflict
potential and “long-term accommodative motivation toward out-groups” (Gudykunst et al., 2005,
p. 15). Watson and Gallois also note that the interpersonal history between the two
communicators also influences their initial orientation stance (1998). Whether an individual
approaches an interaction as inter-personal or inter-group is an important distinction, as each
approach affects one’s accommodation choices and evaluations (Watson & Gallois, 1998).
The third component of CAT involves the actual interaction. According to Gudykunst et
al. there are five aspects of “the immediate situation,” all of which are interrelated (2005, p. 15).
The first aspect is the socio-psychological states of the communicators, which involve the
individuals’ decision to approach the interaction from an inter-personal or inter-group stance
based on the socio-historical context previously reviewed (Ota, Giles, & Somera, 2007). The
second aspect is the “goals and addressee focus,” which addresses individuals’ motivations,
conversational and relational needs (Gudykunst et al., 2005, p. 15).
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The third aspect of the interaction is the accommodation strategies adopted by the
communicators (Gudykunst et al., 2005). Accommodation is the process by which individuals
use communication to signify their attitudes of their communicative other, thereby establishing
levels of social distance (Giles & Ogay, 2007). Individuals have their own expectations and
approach for accommodation dependent on stereotypes and norms (Giles & Ogay, 2007). The
different accommodation styles of CAT follow.
Convergence is an accommodation strategy that can be traced back to the establishment
of the theory (Giles & Ogay, 2007) and is the most studied strategy within CAT’s history
(Hajeck, Villagran, &Wittenberg-Lyles, 2007). Convergence can be defined as when a
communicator alters his/her communication style to be more similar to whom they are
communicating with (Buller & Aune, 1992). Conversely, divergence is defined as “an
accentuation of speech and nonverbal differences between self and other” (Giles & Ogay, 2007),
a strategy whereby dissimilarities are maximized (Buller & Aune, 1992). Another strategy,
maintenance, can be defined as when a person “persists in his or her original style” (Gasiorek &
Giles, 2012). Maintenance is often analyzed closely to divergence, as an individual does not
make an effort to converge to their communicator. However, it is different from divergence in
that that the individual does not place an emphasis on differences (Giles & Ogay, 2007).
According to Giles, accommodation includes strategies of non-accommodation such as
counter-accommodation, under-accommodation and over-accommodation (Gallois et al., 2005).
Non-accommodation strategies may produce neutral, positive or negative outcomes depending
on the context and the individuals interacting (Giles, 2008). Counter-accommodation can be
seen as an extension of divergence, in which an individual’s aim is to maximize differences
between his/herself and their communicative partner. This is often perceived negatively and
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involves harsher behaviors (Gallois at al., 2005). Over-accommodation can be seen as an
extension of convergence when a communicator “over-shoots the level of adjustment felt to be
appropriate in a given situation” (Gasiorek & Giles, 2012, p. 311). Often times, over-
accommodation is the result of positive intentions rather than negative (Giles, 2008).
Conversely, under-accommodation can be seen as an extension of maintenance, when a
communicator fails to accommodate to their communicative partner (Jones et al., 2007).
Gasiorek and Giles make the important note that both over- and under-accommodation are
“subjective phenomena” as they rely on the recipient’s interpretation (2012, p. 311).
The fourth aspect of the interaction involves the behaviors and tactics actually taking
place by communicators. These behaviors are influenced by one another’s behaviors, changing
motives and identities (Gallois et al., 2005). As previously mentioned, communicators may
change their strategies throughout an interaction. The fifth and final aspect involves “labeling
and attributions,” which are made throughout the interaction based on individuals’ perceptions
(Gudykunst et al., 2005, p. 15). The final component of CAT involves “evaluations and future
intentions” (Gudykunst et al., 2005, p. 15). Within this component, CAT addresses how the
communicators evaluate their communicative counterpart and whether or not they are likely to
seek interactions with the individual in the future (Gudykunst et al., 2005).
Major Developments and Influences
As many factors influence an interaction from communicators’ motivations, identities,
perceptions and evaluations, communication accommodation theory (CAT) tackled these
influences by expanding upon other communication theories such as social identity theory (SIT),
similarity attraction theory and attribution theory (Gallois et al., 2005). In its early form, CAT
expanded on ethnolinguistic identity theory (ELIT), as it approached these factors within
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communicators’ speech styles (Gudykunst et al., 2005). As the theory proceeded to consider all
behaviors, so did its expansion upon other existent theories.
Attribution theory is based on the concept that during a communicative interaction,
individuals are working with incomplete information. Specifically, an individual lacks
information regarding their communicative others’ intentions and motives (Gallois et al., 2005).
This finding is prevalent in CAT as the theory proposes that communicators make attributions of
their communicative other’s intentions and motives by evaluating them (Gasiorek & Giles,
2012). In general, if an individual attributes positive motives and intentions to their
communicative partner, they are likely to evaluate them more positively than if they attribute
their motives and intentions as negative (Gallois et al., 2005; Gasiorek & Giles, 2012).
However, according to Gasiorek and Giles, how this process is conducted has not been addressed
within CAT to the extent needed (2012).
Therefore, Gasiorek and Giles conducted two studies of college students and found that
when an individual perceived their communicative partner’s non-accommodation as intentional
and negatively motivated, they were evaluated more negatively than if their non-accommodation
was perceived as positively motivated (whether intentional or not). This finding supported
previous findings regarding evaluation, motivation and intent, and Gasiorek and Giles have
proposed modification of CAT’s propositions to reflect these commonalities (2012).
Social identity theory (SIT) principles are also prevalent within CAT. CAT draws upon a
key assumption of SIT that states “individuals desire a positive social identity” (Lee & Giles,
2008, p. 25). According to Gallois et al. (2005), CAT proposes that individuals “adjust their
speech styles in order to create and maintain positive personal and social identities” (as cited in
Lee & Giles, 2008 p. 9).
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Similarity attraction theory, developed by Byrne (1971), proposes that an increase in
perceived interpersonal similarity results in increased interpersonal attraction (Lee & Giles,
2008). Extended upon within CAT, accommodation strategies can help parties converge to their
communicator, thereby making oneself more similar to their communicative other (Street, Brady,
& Putman, 1983). According to Ota et al. (2007), CAT makes a general proposition that a
communicator whose accommodative strategies are perceived to increase similarity will be
evaluated more positively regarding their “personal traits of competence and social
attractiveness” (as cited in Myers, Giles, Reid, & Nabi, 2008, p. 292).
Addressing Criticisms
Since communication accommodation theory’s (CAT) extension from other theories and
application to a variety of contexts, the amount of propositions has been raised from six to
seventeen (Gallois et al., 2005). CAT has reached a stage where these propositions have raised a
number of concerns. In particular, a current critique of the theory is in regard to its parsimony
(Gallois et al., 2005). The inconsistent terminologies used to refer to its principles and
assumptions are criticized, as they often deviate from and complicate the original propositions
(Gallois et al., 2005). Gallois et al. claim that more recently, research approaches to the theory
have been broad, and lack a certain truth to the theory’s propositions (Gallois et al., 2005).
To return to the core propositions of the theory, Gallois et al. have taken the initiative to
combat this issue and propose a reduction in the number of propositions from 17 to seven
(Gallois et al., 2005). Their hope in doing so is to restore parsimony to the theory. Although
CAT’s propositions make general assumptions, the theory acknowledges that “accommodation
and non-accommodation can be viewed negatively and positively, respectively” (Myers et al.,
2008), depending on the context and the communicators (Williams, Giles, Coupland, Dalby, &
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Manassee, 1990). A criticism regarding this flexibility according to Myers et al. (2008) is that
CAT’s framework could stand to “be refined” (p. 300). Myers et al. believe “precise contextual
conditions” regarding when accommodation and non-accommodation is evaluated positively or
negatively “would be an important theoretical advance” (2008, p. 300). However, to fulfill this
need Giles encourages such researchers to create their own extensions of CAT if need be, in
order to relate it to their context of study while maintaining truth to the theory (Gallois et al.,
2005).
Application to Health Communication
Now that the components of communication accommodation theory (CAT) have been
reviewed and its roots, major developments and current criticisms have been covered, this review
will hone in on the theory’s application within the context of health communication. Further
review and research findings will relate to how CAT’s components are applicable and relevant to
health communications between health care professionals and their patients/clients.
Specific to the healthcare system, CAT provides the field with an opportunity to “expand
upon its theoretical base” (Jones et al., 2007, p. 207). According to Beck et al. (2004), “over
75% of health communication studies did not include a theoretical framework, although this is
changing” (as cited in Jones et al., 2007, p. 207). The importance of theoretical application to
health communication, and specifically the field’s utility of CAT, lies largely in the perceived
power differences among inter-group and inter-personal encounters in the medical field (Jones et
al., 2007). Furthermore, the communication process has the potential to affect an individuals’
health status (Williams et al., 1990). Health professionals, patients and clients can benefit from
understanding the communication process within this context to better enhance the
communicative interactions that take place (Jones et al., 2007).
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According to Park and Watson, most researchers of CAT perceive interactions between
physicians and patients “as a predominately inter-group experience that occurs at the inter-
personal level” (2007, p. 5). Hajek et al. (2007) discuss the inter-group aspect of CAT in patient-
physician interactions, as patients often perceive physicians within their role in a societal group
rather than as an individual, and the same approach holds true vice-versa. Therefore, patients’
expectations of interactions with physicians, and conversely, physicians’ expectations of
interactions with patients, are largely based on norms and stereotypes established from inter-
group relations in the past (Watson & Gallois, 1998; Hajeck et al., 2007). To demonstrate, Ivey
et al. (2000) found that health professionals responsible for the treatment of elder patients’
mental health claimed they have “little capacity for change” because they are “so mentally
deteriorated” (as cited in Nussbaum et al., 2005 p. 296). Such stereotypes may have negative
consequences, and “may explain some of the problems resulting from miscommunication
between physicians and patients” (Nussbaum et al., 2005 p. 295). For example, a common
outcome in the medical field resulting from stereotypes attributed to elder patients is over-
accommodation on behalf of health professionals (Williams et al., 1990).
Aside from norms and stereotypes existent between groups, assuming an inter-group or
inter-personal approach also has the potential to change the effectiveness of an interaction as
deemed by either communicator in an interaction (Gallois et al., 2005). A study of interactions
between nurses and parents of infant patients in the neonatal intensive care unit (NICU) found
that approaches might conflict between the communicators (Jones et al., 2007). The study found
mothers of infant patients more likely to approach an encounter with the infants’ nurse as inter-
personal, where mother and nurse work together. However, consistent with other studies, nurses
were more likely to approach the interaction as inter-group, where it is their role as the caretaker
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to educate mothers and serve as a protector of the infant (Jones et al., 2007).
Regardless of one’s intention to approach the interaction from an inter-group or inter-
personal stance, how their communicator evaluates their stance also effects medical interactions.
The study within the NICU environment found that when inter-personal and/or inter-group
differences were perceived to be minimized and similarities maximized, parents evaluated the
interaction as more effective and positive (Jones et al., 2007). Another study found that when
attending to patients’ emotional needs, physicians who were evaluated as inter-personal were
rated more positively on their accommodation strategies (Watson & Gallois, 1998). Similarly,
inter-personally rated physicians were perceived to use more accommodating strategies and were
seen as more nurturing (Watson & Gallois, 1998). Consistent with the findings of Jones et al.
(2007), Watson and Gallois study also found physicians to be evaluated more positively the less
they emphasized power or group differences (1998). The results of these studies suggest that
health professionals can benefit from approaching a communication interaction from an inter-
personal approach and minimizing differences between themselves and their patients and/or
clients (Jones et al., 2007).
However, adapting one’s orientations may not be so easy to alter in a potentially high
stakes environment (Jones et al., 2007). In a health communication setting, physicians and
patients may have conflicting motives and intentions for their communication in an interaction.
According to Ong et al., while health professionals may be motivated to seek relevant
information toward making a diagnosis, patients or clients are often more motivated to ensure
that they are being understood and in turn, understand the information given to them (as cited in
Jones et al., 2007).
Williams et al. also acknowledge conflictions regarding patients’ motivation to seek
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support within a healthcare environment. Patients may or may not be motivated to seek support
depending upon perceptions of their own identity and sense of control (Williams et al., 1990).
Though concerned with their own sense of identity, patients are less concerned with physicians’
identity when it comes to accommodation. Hajeck et al., found that patients expect physicians to
accommodate regardless if they perceive them to be an out-group member or not (2007).
Important to this expectation of physician accommodation, Hajeck et al. also found that
physicians’ accommodation styles effect patients’ compliance regarding medical suggestions
(2007). Williams et al. (1990) elaborate on this notion stating that patients who evaluate health
providers’ accommodation as positive are more likely to trust and comply with their medical
advice. Conversely, if patients perceive physicians’ accommodation strategies negatively, they
are more likely to avoid interactions in the future and quality care may be at stake (Williams et
al., 1990).
However, during a physician-patient/client interaction, perceptions of positive versus
negative accommodation may vary. For example, studies show physicians may be perceived as
over-accommodating by “over-simplifying” their speech when discussing medical care, even if
the physicians have positive intentions and believe they are converging appropriately (Jones et
al., 2007). According to Gallois et al., conflictions between a communicator’s intent and their
partner’s perception are common within interactions that are defined by role and status
differences, such as the patient-physician interaction (2005). Accommodation tactics can be
evaluated negatively regardless of positive or negative intentions; therefore, consideration of
patients’ perceptions is important (Giles, 2008).
The study conducted by Jones et al. (2007) sought to address such issues related to
patients’ evaluations by exploring what CAT strategies and accommodation practices are
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associated with evaluating a communicative encounter as successful versus unsuccessful (Jones
et al., 2007). Results showed that mothers and fathers of infant patients perceived nurses’
accommodative strategies of discourse management and emotional expression (asking questions,
encouraging participation, showing warmth and empathy) as effective (Jones et al., 2007).
Conversely, when non-accommodating strategies were deployed, such as under-accommodation
on nurses’ behalf in regard to interpretability (failing to check if the parents’ were
comprehending the information), parents deemed the interaction as ineffective (Jones et al.,
2007).
Similar findings regarding negative evaluations of physicians’ non-accommodation
prevailed in a study where over 60% of elder patients within a care facility felt “patronized” by
caregivers’ over-accommodation in regard to their use of “infantile patterns of communication”
(Lagacé, Tanguay, Lavallée, Laplante, & Robichaud, 2012, p. 338). Results suggested that
recipients evaluated the caretakers’ over-accommodating behaviors negatively, as there was a
significant association between recipients of over-accommodation and reports of high
dissatisfaction with quality of life within the facility (Lagacé et al., 2012).
Future Research in Health Communication
These studies have major implications for the medical field as health professionals can
benefit from “an increased awareness of adapting their communication style” to the preferences
of their clients and/or patients (Jones et al., 2007, p. 211). However, as previously mentioned,
health providers’ initial orientation to the interaction may not be so simple. Further research
studying communicative interactions from the health professionals’ perspective may shed light
on the importance of maintaining an inter-group approach, as social structures and rules may
constrict their communicative mobility (Williams et al., 1990).
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In relation, the above referenced studies of communication accommodation theory’s
(CAT) propositions within medical interactions analyzed effective versus ineffective health
interactions from the client/patient perspective. Future research would benefit from further
exploration of effective versus ineffective interactions and accommodation strategies as
perceived by health providers (Jones et al., 2007).
To further expand CAT’s application and research to medical interactions, future studies
should also explore intentions, motives, expectations, and factors that affect evaluation of
ineffective versus effective accommodation strategies within various specific health
communication interactions. Researchers should consider the extent to which patients’
demographics, previous experiences with the medical arena and frequency of medical
interactions influence physicians’ accommodation strategies during a health interaction (Hajeck
et al., 2007).
Additionally, past research findings, even if not directly related to medical interaction,
have the potential to be expanded upon within the health communication context. For example,
Gasiorek and Giles’ (2012) previously mentioned findings, (that when an individual perceived
their partner’s non-accommodation as intentional and negatively motivated they were more
likely to be evaluated negatively), may prove applicable to health interactions.
Because their study’s participants were college students and predominantly female
(Gasiorek & Giles, 2012), future research regarding patients’ perceptions of health providers’
intent and motive and how it affects evaluations has the potential to expand their sample and
support their findings within the medical field. This study would be beneficial to medical
interactions, as the link has already been established regarding patients’ evaluations and their
willingness to comply with medical advice (Williams et al., 1990; Hajeck et al., 2007).
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As the opportunities for future research have been addressed, it is clear there is much
room for development regarding CAT and the medical field. To quote the man behind the
theory, Giles said, “as an evolving and adaptive species, we naturally have to adjust to our
surrounds; this means accommodating as we as non-accommodating each other” (Giles, 2008, p.
125). Furthermore, he acknowledges how “accommodation strategies have been discussed in a
range of life- and death-involving situations” (Giles, 2008, p. 125). In the healthcare field, both
life and death situations are surely at the forefront. It is with this notion that future researchers
and professionals in the communication and healthcare arenas are wise to continue to consider
and expand upon communication accommodation theory by both creating their own extensions
and remaining true to the heart of the theory.
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